Autologous fibrin sealant reduces the incidence of prolonged air leak and duration of chest tube drainage after lung volume reduction surgery: a prospective randomized blinded study.
OBJECTIVE
Prolonged air leak is reported in up to 50% of patients after lung volume reduction surgery. The effect of an autologous fibrin sealant on the intensity and duration of air leak and on the time to chest drain removal after lung volume reduction surgery was investigated in a randomized prospective clinical trial.


METHODS
Twenty-five patients underwent bilateral thoracoscopic lung volume reduction surgery. In each patient, an autologous fibrin sealant was applied along the staple lines on one side, whereas no additional measure was taken on the other side. Randomization of treatment was performed at the end of the resection on the first side. Air leak was assessed semiquantitatively by use of a severity score (0 = no leak; 4 = continuous severe leak) by two investigators blinded to the treatment.


RESULTS
Mean value of the total severity scores for the first 48 hours postoperative was significantly lower in the treated group (4.7 +/- 7.7) than in the control group (16.0 +/- 10.1) (P < .001), independently of the length of the resection. Prolonged air leak and mean duration of drainage were also significantly reduced after application of the sealant (4.5% and 2.8 +/- 1.9 days versus 31.8% and 5.9 +/- 2.9 days) (P = .03 and P < .001).


CONCLUSIONS
Autologous fibrin sealant for reinforcement of the staple lines after lung volume reduction surgery significantly reduces prolonged air leak and duration of chest tube drainage.
Moser
C
C
Division of Thoracic Surgery, University Hospital Zürich, Zurich, Switzerland.
Opitz
I
I
Zhai
W
W
Rousson
V
V
Russi
E W
EW
Weder
W
W
Lardinois
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D004311:Double-Blind Method; D015916:Drainage, Postural / Q000379:methods*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011030:Pneumothorax / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D011336:Probability; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D012016:Reference Values; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive